Radiotherapy and Surgical Advances in the Treatment of Metastatic Spine Tumors: A Narrative Review

Porras, Jose L.; Pennington, Zach; Hung, Bethany; Hersh, Andrew; Schilling, Andrew; Goodwin, C. Rory; Sciubba, Daniel M.

doi:10.1016/j.wneu.2021.05.032

Cited by 9 publications

(10 citation statements)

References 93 publications

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“…The main limitation of the SINS is that the majority of patients are generally classified as undetermined instability (7)(8)(9)(10)(11)(12), a situation in which the experience of the specialist is still necessary for a subjective assessment of the conduct to be followed. One possibility could be to increase the cut-off value and revising the domains may improve the diagnostic performance to predict the risk of fracture of the SINS.…”

Section: Limitation Of the Sinsmentioning

confidence: 99%

“…The spine is the most common site of bone metastases in general and skeletal metastases in particular, with a prevalence of 30-70% and 20-40% in cancer patients respectively (1,2).Thus, spinal metastases are a concerning health issue as well as an economic burden (3,4), despite the fact that the management of these patients has considerably evolved both in terms of surgery and radiotherapy (RT) (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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Ten Years After SINS: Role of Surgery and Radiotherapy in the Management of Patients With Vertebral Metastases

Serratrice¹,

Faddoul

Tarabay³

et al. 2022

Front. Oncol.

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The objective of the different types of treatments for a spinal metastasis is to provide the best oncological and functional result with the least aggressive side effects. Initially created in 2010 to help clinicians in the management of vertebral metastases, the Spine Instability Neoplastic Score (SINS) has quickly found its place in the decision making and the treatment of patients with metastatic spinal disease. Here we conduct a review of the literature describing the different changes that occurred with the SINS score in the last ten years. After a brief presentation of the spinal metastases’ distribution, with or without spinal cord compression, we present the utility of SINS in the radiological diagnosis and extension of the disease, in addition to its limits, especially for scores ranging between 7 and 12. We take this opportunity to expose the latest advances in surgery and radiotherapy concerning spinal metastases, as well as in palliative care and pain control. We also discuss the reliability of SINS amongst radiologists, radiation oncologists, spine surgeons and spine surgery trainees. Finally, we will present the new SINS-derived predictive scores, biomarkers and artificial intelligence algorithms that allow a multidisciplinary approach for the management of spinal metastases.

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Section: Limitation Of the Sinsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ten Years After SINS: Role of Surgery and Radiotherapy in the Management of Patients With Vertebral Metastases

Serratrice¹,

Faddoul

Tarabay³

et al. 2022

Front. Oncol.

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“…However, when tumor management is urgent, multidisciplinary discussions risk creating treatment delays [ 44 ]; thus, decisions must be made quickly, especially for metastatic patients with acute neurological deficits. Furthermore, the management of complex spinal lesions is increasingly recognized to necessitate a concerted effort, encompassing the combined opportunities of radiotherapy, chemotherapy, and operative techniques [ 6 , 22 ]. Nonetheless, surgery has been demonstrated to be the most effective strategy in patients with neurological deficits and bone instability [ 22 ].…”

Section: Current Treatment Strategies and Their Limitationsmentioning

confidence: 99%

“…A broad spectrum of treatments is available for spine tumors, ranging from radiation to highly invasive en bloc resection [ 6 ]. However, spine oncology therapeutic strategies exhibit certain drawbacks that limit their application and efficacy.…”

Section: Introductionmentioning

confidence: 99%

“…Several surgical techniques can be employed when tumor excision is required, depending on tumor type, surgery goal, and overall patient health status [ 6 , 15 ]. To improve procedure precision and postoperative outcomes, emerging digital technologies started being incorporated into tumor resections as complementary instruments for visualizing the surgical field [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Current and Emerging Approaches for Spine Tumor Treatment

Costăchescu

Niculescu

Iliescu

et al. 2022

IJMS

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Spine tumors represent a significant social and medical problem, affecting the quality of life of thousands of patients and imposing a burden on healthcare systems worldwide. Encompassing a wide range of diseases, spine tumors require prompt multidisciplinary treatment strategies, being mainly approached through chemotherapy, radiotherapy, and surgical interventions, either alone or in various combinations. However, these conventional tactics exhibit a series of drawbacks (e.g., multidrug resistance, tumor recurrence, systemic adverse effects, invasiveness, formation of large bone defects) which limit their application and efficacy. Therefore, recent research focused on finding better treatment alternatives by utilizing modern technologies to overcome the challenges associated with conventional treatments. In this context, the present paper aims to describe the types of spine tumors and the most common current treatment alternatives, further detailing the recent developments in anticancer nanoformulations, personalized implants, and enhanced surgical techniques.

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Boron neutron capture therapy delays the decline in neurological function in a mouse model of metastatic spinal tumors

Fujikawa,

Kawabata,

Tsujino

et al. 2024

Cancer Science

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Metastatic spinal tumors are increasingly prevalent due to advancements in cancer treatment, leading to prolonged survival rates. This rising prevalence highlights the need for developing more effective therapeutic approaches to address this malignancy. Boron neutron capture therapy (BNCT) offers a promising solution by delivering targeted doses to tumors while minimizing damage to normal tissue. In this study, we evaluated the efficacy and safety of BNCT as a potential therapeutic option for spine metastases in mouse models induced by A549 human lung adenocarcinoma cells. The animal models were randomly allocated into three groups: untreated (n = 10), neutron irradiation only (n = 9), and BNCT (n = 10). Each mouse was administered 4‐borono‐L‐phenylalanine (250 mg/kg) intravenously, followed by measurement of boron concentrations 2.5 h later. Overall survival, neurological function of the hindlimb, and any adverse events were assessed post irradiation. The tumor‐to‐normal spinal cord and blood boron concentration ratios were 3.6 and 2.9, respectively, with no significant difference observed between the normal and compressed spinal cord tissues. The BNCT group exhibited significantly prolonged survival rates compared with the other groups (vs. untreated, p = 0.0015; vs. neutron‐only, p = 0.0104, log‐rank test). Furthermore, the BNCT group demonstrated preserved neurological function relative to the other groups (vs. untreated, p = 0.0004; vs. neutron‐only, p = 0.0051, multivariate analysis of variance). No adverse events were observed post irradiation. These findings indicate that BNCT holds promise as a novel treatment modality for metastatic spinal tumors.

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Radiotherapy and Surgical Advances in the Treatment of Metastatic Spine Tumors: A Narrative Review

Cited by 9 publications

References 93 publications

Ten Years After SINS: Role of Surgery and Radiotherapy in the Management of Patients With Vertebral Metastases

Ten Years After SINS: Role of Surgery and Radiotherapy in the Management of Patients With Vertebral Metastases

Current and Emerging Approaches for Spine Tumor Treatment

Boron neutron capture therapy delays the decline in neurological function in a mouse model of metastatic spinal tumors

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